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Plantar Fasciitis

Plantar fasciitis is a disorder that results in pain in the heel and bottom of the foot. The pain is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin and may be worsened by a tight Achilles tendon.

Risk factors include overuse such as from long periods of standing, and/or an increase in exercise. While heel spurs are frequently found it is unclear if they have a role in causing the condition. Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring. As inflammation plays a lesser role, a review proposed it be renamed plantar fasciosis. 

The diagnosis is typically based on signs and symptoms, in addition, ultrasound is sometimes used. Other conditions with similar symptoms include osteoarthritis, ankylosing spondylitis, heel pad syndrome, and reactive arthritis.

Most cases of plantar fasciitis resolve with time and conservative methods of treatment. Usually for the first few weeks, people are advised to rest, orthotics, possibly physiotherapy. If these measures do not work, extracorporeal shockwave therapy.

The cause of plantar fasciitis is thought to likely have several contributing factors. The plantar fascia is a thick fibrous band of connective tissue that originates from the medial tubercle and anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting at the base of the toes, and supports the arch of the foot.

Plantar fasciitis is due to a noninflammatory structural breakdown of the plantar fascia. The structural breakdown of the plantar fascia is believed to be the result of repetitive microtrauma. Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers.

Disruptions in the plantar fascia's normal mechanical movement during standing and walking contribute to the development of plantar fasciitis by placing excess strain on the calcaneal tuberosity. Other studies have also suggested that plantar fasciitis is not actually due to inflamed plantar fascia, but may be a tendon injury involving the flexor digitorum brevis muscle located immediately deep to the plantar fascia.

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